The prevalence of overweight and obesity in children is very high and the incidence is increasing, especially among ethnic minority children. Obesity in childhood is associated with a high risk of continued obesity into adolescence and adulthood. This is of great public health significance because obesity increases risk for the development of type 2 diabetes and cardiovascular disease. Empirically validated interventions are available for the treatment of pediatric obesity. However, one of the major barriers to treatment is access to effective treatment programs;therefore, most overweight children do not receive formal family-based behavioral weight control intervention. A key issue in dealing with the epidemic of pediatric obesity is how to provide effective treatment to the population of overweight children. Pediatricians'increased attention to this significant issue affords an opportunity for providing greater access to effective intervention. Health insurance companies are another key stakeholder in the pediatric obesity epidemic, as effective treatment will ultimately reduce health care expenditures related to obesity over time. We envision a system in which pediatricians identify overweight children as part of routine primary care, and then refer families to a web site designed to increase their awareness of the problem of obesity, as well as increase their motivation to engage in lifestyle change to reduce obesity through the development of healthful dietary and physical activity habits. The web site will be accessed by children and parents over time and the system will generate reports on usage, as well as self- reported health behaviors and weight changes to be sent electronically to the referring pediatricians. In our Phase I research, we developed an innovative web program to support pediatric weight loss, based on those principles shown to be effective in clinical research studies of obese children, as well as input from focus groups of overweight children, their parents, and pediatricians. In a one month trial, we found that children who utilized the web site frequently had significant reductions in BMI and improvements in health behaviors and self-efficacy for weight control. During Phase II we will work with Klein Buendel of Denver, CO, to modify and adapt the prototype version to develop the complete intervention program for use in the primary care pediatric setting and home environment. Klein Buendel is a leader in the use of technology for health promotion. The evidence-based program will build upon the same format as the prototype from Phase I with all of the concepts, skills, and modules included in the family weight control intervention, but with additional video components and interactive games. We will conduct a six-month randomized controlled trial to determine the effects of using the program on BMI, health behaviors, motivation, and quality of life. We will then develop final versions of the interactive web-based program for marketability to health insurance companies and pediatricians.

Public Health Relevance

Childhood obesity is very prevalent and of great public health significance. Evidence-based interventions are available to treat obesity in children, yet most children do not receive such interventions. The proposed research will finalize development of an innovative web-based family intervention program that links children and parents to pediatricians, and tests its efficacy in a six-month randomized controlled trial.